BMJ  2006;333:334-339 (12 August), doi:10.1136/bmj.333.7563.334

Clinical review

Infective endocarditis

Rhys P Beynon, specialist registrar1, V K Bahl, professor of cardiology2, Bernard D Prendergast, consultant cardiologist1

1 Department of Cardiology, Wythenshawe Hospital, Manchester M23 9LT, 2 All India Institute of Medical Sciences, New Delhi, India

Correspondence to: B D Prendergast Bernard.Prendergast@smuht.nwest.nhs.uk

The first 150 words of the full text of this article appear below.

Introduction

The investigation and management of infective endocarditis in the developed world have changed radically over the past 30 years.1 Non-invasive imaging, molecular science, diagnostic protocols, and curative surgery have all become commonplace, yet the incidence remains unchanged and annual mortality approaches 40%.2

The lack of impact of modern medicine reflects important changes in the causes of the disease. In Western populations in particular, chronic rheumatic heart disease is now an uncommon antecedent, whereas degenerative valve disease in elderly people, intravenous drug misuse, preceding valve replacement, or vascular instrumentation have become increasingly frequent, coinciding with an increase in staphylococcal infections and those due to fastidious organisms. Furthermore, previously undetected pathogens are now being identified with the disease, and multidrug resistant bacteria challenge conventional treatment regimens. Meanwhile, rheumatic valve disease remains endemic in the developing world, where modern investigations and management are the privilege of the well off few who live in . . . [Full text of this article]

Who gets infective endocarditis?

What is the underlying pathophysiology?

How do patients present?

How to investigate endocarditis: take blood cultures first, treat later

Antimicrobial treatment

Special subgroups

Who needs cardiac surgery?

Prophylaxis

International collaboration

The future


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